Provider Demographics
NPI:1942463005
Name:ENDOCRINE ONE ADVANCED DIABETES ENDOCRINE CARE LLC
Entity Type:Organization
Organization Name:ENDOCRINE ONE ADVANCED DIABETES ENDOCRINE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:H
Authorized Official - Last Name:KAILANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-873-7171
Mailing Address - Street 1:855 BELANGER ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4463
Mailing Address - Country:US
Mailing Address - Phone:985-873-7171
Mailing Address - Fax:
Practice Address - Street 1:855 BELANGER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4463
Practice Address - Country:US
Practice Address - Phone:985-873-7171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty